The Vaccination Population Gap and High-Risk Strata

A discussion regarding the population gap in vaccine coverage and the patient groups at high-risk if not immunized.

Troy Trygstad, PharmD, MBA, PhD: Mike, you are with a technology company that also collects a lot of data and works with a lot of public health officials, public health databases and registries. Is this the forgotten strata, the 18 to 49 middle aged group—those that are otherwise healthy? You know, the challenge with vaccinations, of course, is that we’re trying to prevent some event that may happen in the future. Epidemiology says that it makes a lot of sense, and that it’s a really good decision to make you get that vaccination. But we’re all indestructible after 1949, right?

Michael Popovich: That’s right.

Troy Trygstad, PharmD, MBA, PhD: What is it that we should be doing to encourage more vaccinations in that population?

Michael Popovich: You’re exactly right. You know we’re all used to our families making sure that kids see the pediatrician, get their full complement of immunizations for school certificates. You get out, you move on, and then now you’re a young adult who knows everything, but you’re really oblivious to everything. But disease keeps plugging away, and the next thing you know, there’s a meningitis issue at a college or something like that. What’s critical is this group is kind of the forgotten group. You have to figure out ways to reach out to them and you have to touch them in different ways than we do in the past by going through their applications or presenting data that begins to empower them. And then they’re adults and it’s just a missing element here, which creates a lot of risk if we’re not careful.

Troy Trygstad, PharmD, MBA, PhD: And you see that in your data.

Michael Popovich: Yes.

Troy Trygstad, PharmD, MBA, PhD: You see the biggest gaps, particularly in the non-flu vaccinations or in that middle-aged category.

Michael Popovich: You can go back to the early adolescents who get the HPV [human papillomavirus] vaccination, and you’ll see that in those males and females who get that first dose, only 50% of those eligible will get it, and that’s what the data tells you. But then you’ll look at the series completion and only half get the second dose. And so there’s a risk factor there for these folks they won’t even know about. A cancer may occur down the road that they could have prevented it by getting that second dose. So the data and the information that is being collected now is really a rich resource to help reach out and close some of those gaps in those hard-to-reach subpopulations.

Troy Trygstad, PharmD, MBA, PhD: And, Emily, your main product is providing information to the point of care in the pharmacy with respect to which populations are outliers or need these vaccinations. What sort of tools are you providing to pharmacies to re-emphasize this population?

Emily Endres: As it relates to immunizations—and maybe slightly agnostic to the particular age population, but more on a grand scope of irons here—we are providing those targeted opportunities to pharmacies using payer data. We partner with our payers that utilize the platform. We bring in multiple data sources, medical claims data and pharmacy data. We’re trying to give an actual target opportunity to the pharmacy based on that member’s behavior over the course of the calendar year.

As we think about the shift in healthcare to a value-based arrangement, particularly in pharmacy, which has accelerated a lot over the last few years, it becomes really important when you have that patient at your counter that you have a holistic view: bringing in immunization, which I know you guys do a lot in your pharmacy, right? Bring in the immunization discussion while you’re talking about diabetes, cholesterol, hypertension, etcetera, all of those other disease states as you’re working to provide additional quality metrics. This helps to bring that conversation into a holistic view. It’s a great opportunity to really provide patient care along that entire continuum and not just focus on one particular disease.

Troy Trygstad, PharmD, MBA, PhD: We’re having this conversation about the broader patient population, and what everybody should be getting as immunizations, but then we have these subpopulations where there’s this extra emphasis potentially. There’s no better example than these travel clinics, right?

Tana Kaefer, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: You’re not getting into this country unless you have this certain vaccine. What other categories of vaccines and types of populations and conditions are there where we say, “Look, we want to make the best effort we can to immunize everybody that walks in the door that needs an immunization.” Where do we place extra emphasis and say, “This is a real issue if you do not get this vaccination sometime soon”?

Tana Kaefer, PharmD: Certainly patients with comorbid conditions, we want to let them know that because of those conditions they’re at increased risk for other vaccine-preventable diseases. Sometimes they don’t know that. They don’t realize that having diabetes, or smoking, or having lung disease, puts me at higher risk for things, so identifying that and having that conversation with them I think is important. Because a lot of times you don’t know what you don’t know.

Troy Trygstad, PharmD, MBA, PhD: You have a special circumstance where it’s required by law to receive a certain vaccination.

Tana Kaefer, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: Or you have a condition or a circumstance where you’re really at extra risk. How does that look at your locations, Dorothy? How do your technologies emphasize circumstances that need extra emphasis?

Michael Popovich: Go ahead.

Dorothy Loy, PharmD, MBA: This ties back to what we mentioned before to treating that patient holistically. When they’re coming in for their medication refills, or if we’re doing a medication therapy management session with the patient, we need to identify the other immunizations that they may need and really explain why. Why is it important for this particular patient? And talking about the fact that they are not just increasing the risk for themselves, but also the people around them. So maybe they have lung disease and are around a lot of school children, because they work at the school, and know that this circumstance is a risk factor for them. We need to do an assessment with them and give them the tools and information so that they can understand that and do the assessment on their own.

Michael Popovich: I agree. And the power here is that if somebody comes in for their prescription data because they’re a diabetic, that pharmacist also knows if they have any immunization care gaps at that time and they have access to that information. Yes, they can fill the prescriptions, but at the same time they can say, “By the way, it’s critical you stay current with this vaccination.” There’s subpopulations of individuals that we don’t normally think of, which should pay attention to the immunization. We need to have that information at the fingertips of the pharmacist when they have those conversations. It’s a big deal because you can just save somebody’s life. They’re not going to catch something that they shouldn’t have gotten because you didn’t have the right conversation.